Plymouth Children s Speech Language Service 2005 to now

1. Plymouth Children�s Speech & Language Service 2005 to now� Dr Gaye Powell Head of Speech & Language Services (Adults & Children) NHS Plymouth

2. Where were we in 2005? Long waiting times for intervention (up to 3 years) because�.. Targets � 13 week to assessment 1500+ referrals per year Capacity v demand caseload imbalance 3000+ for 9 wte community staff �Consultation� and �filing cabinet� model Inequitable and variable access to service across city High incidence of SLT difficulties at mainstream school entry

3. Additional issues Lack of information all round Therapeutic need v diagnosis of the children? What does �having� Speech & Language Therapy mean? Lack of clear care pathway/journey and expectations Poor support for written �communication programmes� High number of complaints ++ Staff stress high and morale low � trying to do it all

4. The way we were 2005!

5. Causes of difficulties High referral rates: 100+ per month Large caseloads � �duty of care� opened (including special schools medical example) Inconsistent/lack of support for advice in context, dependency Lack of cause and effect relationship Poorly defined care pathway/journey Make up the workforce Inclusion +ve & -ve Historical under funding and only health

6. Needed to do something different�.

7. Children�s SLT Service review objectives establish population needs and trends establish what SLT in Plymouth is�.core business challenge �traditional� unproven and �lip service� models ensure transparency & honesty for service users provide clearly defined explicit goal driven intervention evidence based, effective, efficient service delivery ensure equity optimise staff resource - skill mix reduce need for service (preventative) enhance staff working experience and job satisfaction

8. Some numbers� 2005 Community 8 wte (1wte off) 3000 children on open caseload Specialist settings LD pre school (1) 0.7 wte HI 0.6 wte SLI � 1.9 (3-16 yrs) Downham � 0.5 wte Millford � 0.9 wte Longcause/Courtlands/ Hillside � 1wte Woodlands � 0.6 wte ASD � 0.6 wte (mat leave) 5.9 wte - 1111 open caseload

9. Actions taken 2005 onwards Two prong approach 1. Determine the needs & how best to meet them 6 month validation of open caseload needs Service redesign 2. Where possible help reduce the difficulties �It�s good to talk with babies and children�in Plymouth� BLAST (Children�s Services LA funded packs) Early Years secondments to support importance of early interaction (Children�s Services LA funded)

10. Community review - September 2005�Total caseload reviewed for:? Speech, language, communication need? Mode of service delivery (who + where)? Skill mix reviewed? Roles and responsibilities of SLT team? Examined current �journey� � range of users Community Caseload � 2,400 Ratio 1:300 Specialist (not yet�) Caseload � 1111 Ratio 1:138 Different skills in settings

11. Profile of need community (with included children)

12. How intervention needed to be delivered (1866 January 06)

13. Speech & Language Therapy (SLT) What does �having it� mean? What it doesn�t do � However � It can diagnose, provide intervention, advice & training for ongoing support to enhance skills & reduce �impact� of difficulties

14. Successful SLT intervention is underpinned by a number of factors relevance / value /motivation and commitment timeliness in relation to other factors frequency, opportunity and reinforcement context for learning � �swimming out of water� empowerment � skills for others time limited measurable and able to demonstrate change

15. New intervention and advice: referral form and re-referral with parental consent � to keep informed based on clinical risk (difference SLT can make ) time limited episodes child centred v service led (timing) based on skill mix goal driven to allow evaluation evidence based and evidence gathering (action research) Intensive & modelling skills for others � seeing is doing!

16. consent and ALL relevant information to progress to TRIAGE

17. What else have we done? New teams �inner� & �outer� city & �flexi� Established central referral & allocation system Fast track re-referral Redefined roles and responsibilities and changed working practice � more hands on Developed clearly defined intervention packages based on skill mix Care Aims training February 2006 Developed Data system to collect meaningful information for service delivery and development Baseline questionnaire to referrers - repeat 2009 Pre and post intervention questionnaires/interviews Summer/Autumn 2007 Special schools written to, caseload & delivery review�ongoing

18. � Health ++, schools +, LA ASD pre-school

19. What we need to happen� Joint commissioning Schools have funding devolved so decisions to be made.. across needs Bercow recommendations to be implemented Continue to evaluate and produce evidence

20. Thank you and questions�.